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Borghaei H, O'Byrne KJ, Paz-Ares L, Ciuleanu TE, Yu X, Pluzanski A, Nagrial A, Havel L, Kowalyszyn RD, Valette CA, Brahmer JR, Reck M, Ramalingam SS, Zhang L, Ntambwe I, Rabindran SK, Nathan FE, Balli D, Wu YL. Nivolumab plus chemotherapy in first-line metastatic non-small-cell lung cancer: results of the phase III CheckMate 227 Part 2 trial. ESMO Open 2023; 8:102065. [PMID: 37988950 PMCID: PMC10774956 DOI: 10.1016/j.esmoop.2023.102065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/09/2023] [Accepted: 10/18/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND In CheckMate 227 Part 1, first-line nivolumab plus ipilimumab prolonged overall survival (OS) in patients with metastatic non-small-cell lung cancer (NSCLC) and tumor programmed death-ligand 1 (PD-L1) expression ≥1% versus chemotherapy. We report results from CheckMate 227 Part 2, which evaluated nivolumab plus chemotherapy versus chemotherapy in patients with metastatic NSCLC regardless of tumor PD-L1 expression. PATIENTS AND METHODS Seven hundred and fifty-five patients with systemic therapy-naive, stage IV/recurrent NSCLC without EGFR mutations or ALK alterations were randomized 1 : 1 to nivolumab 360 mg every 3 weeks plus chemotherapy or chemotherapy. Primary endpoint was OS with nivolumab plus chemotherapy versus chemotherapy in patients with nonsquamous NSCLC. OS in all randomized patients was a hierarchically tested secondary endpoint. RESULTS At 19.5 months' minimum follow-up, no significant improvement in OS was seen with nivolumab plus chemotherapy versus chemotherapy in patients with nonsquamous NSCLC [median OS 18.8 versus 15.6 months, hazard ratio (HR) 0.86, 95.62% confidence interval (CI) 0.69-1.08, P = 0.1859]. Descriptive analyses showed OS improvement with nivolumab plus chemotherapy versus chemotherapy in all randomized patients (median OS 18.3 versus 14.7 months, HR 0.81, 95.62% CI 0.67-0.97) and in an exploratory analysis in squamous NSCLC (median OS 18.3 versus 12.0 months, HR 0.69, 95% CI 0.50-0.97). A trend toward improved OS was seen with nivolumab plus chemotherapy versus chemotherapy, regardless of the tumor mutation status of STK11 or TP53, regardless of tumor mutational burden, and in patients with intermediate/poor Lung Immune Prognostic Index scores. Safety with nivolumab plus chemotherapy was consistent with previous reports of first-line settings. CONCLUSIONS CheckMate 227 Part 2 did not meet the primary endpoint of OS with nivolumab plus chemotherapy versus chemotherapy in patients with metastatic nonsquamous NSCLC. Descriptive analyses showed prolonged OS with nivolumab plus chemotherapy in all-randomized and squamous NSCLC populations, suggesting that this combination may benefit patients with untreated metastatic NSCLC.
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Affiliation(s)
- H Borghaei
- Fox Chase Cancer Center, Philadelphia, USA.
| | - K J O'Byrne
- Princess Alexandra Hospital and Queensland University of Technology, Brisbane, Australia
| | - L Paz-Ares
- Hospital Universitario 12 de Octubre, Universidad Complutense & CiberOnc, Madrid, Spain
| | - T-E Ciuleanu
- Institutul Oncologic Prof. Dr. Ion Chiricuţă and UNF Iuliu Haţieganu University, Cluj-Napoca, Romania
| | - X Yu
- Zhejiang Cancer Hospital, Hangzhou, China
| | - A Pluzanski
- Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - A Nagrial
- Blacktown Hospital, Sydney, Australia
| | - L Havel
- Thomayer Hospital, Charles University, Prague, Czech Republic
| | | | | | - J R Brahmer
- Johns Hopkins, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, USA
| | - M Reck
- Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany
| | - S S Ramalingam
- Winship Cancer Institute, Emory University, Atlanta, USA
| | - L Zhang
- Sun Yat-Sen University Cancer Center, Guangdong, China
| | - I Ntambwe
- Bristol Myers Squibb, Princeton, USA
| | | | | | - D Balli
- Bristol Myers Squibb, Princeton, USA
| | - Y-L Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong, China
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Valette CA, Filleron T, Debieuvre D, Lena H, Pérol M, Chouaid C, Simon G, Quantin X, Girard N. Treatment patterns and clinical outcomes of extensive stage small cell lung cancer (SCLC) in the real-world evidence ESME cohort before the era of immunotherapy. Respir Med Res 2023; 84:101012. [PMID: 37307617 DOI: 10.1016/j.resmer.2023.101012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 03/13/2023] [Accepted: 03/18/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Small cell lung cancer (SCLC) is a highly aggressive entity of lung cancer with tendency toward early recurrence after first-line treatment. As per recently updated European Society for Medical Oncology recommendations, first-line treatment with up to 4 cycles of platinum-etoposide combined with immune checkpoint inhibitor (ICIs)-targeting PD-L1, is now the standard of care. The purpose of the current analysis is to identify current patient profiles and treatment strategies in real life clinical practice, and report outcomes in Extensive Stage (ES)-SCLC. METHODS Non-interventional, retrospective, multicentre, comparative study was carried out to describe the outcome of ES-SCLC patients included in the Epidémiologie Stratégie Médico-Economique (ESME) data platform for advanced and metastatic lung cancer. Patients were selected from 34 health care facilities between January 2015 and December 2017, before the era of immunotherapy. RESULTS 1315 patients were identified, including 64% male and 78% under 70 year-old; 24% had at least 3 metastatic sites, mainly liver metastases (43%), bone metastases (36%), brain metastases (32%). 49% received only one line of systemic treatment; 30% and 21% received 2 and 3 lines or more, respectively. Carboplatin was more frequently used than cisplatin (71% and 29%, respectively). Prophylactic cranial irradiation was infrequent (4% of patients), but 16% of patients received thoracic radiation therapy, mainly after the completion of first-line chemotherapy (72% of patients); such strategies were more frequently applied in cisplatin/etoposide than carboplatin/etoposide patients (p = 0.006 and p = 0.015, respectively). After a median follow-up time of 21.8 (95% CI: 20.9-23.3) months, median real-world Progression-Free Survival (rw-PFS) was 6.2 (95% CI: 5.7; 6.9) and 6.1 (95% CI: 5.8; 6.3) months for cisplatin/etoposide and carboplatin/etoposide doublet regimens, respectively; 24-month rwPFS and Overall Survival were 3.2% (95% CI: 2.3; 4;2) and 22.2% (95% CI: 19.4; 25.1) in the whole population, respectively. CONCLUSION Our data provide with landmark reference findings on ES-SCLC before the immunotherapy era, and cover many aspects of the treatment strategy, while highlighting on the role of radiotherapy, subsequent lines of therapy, and the outcomes of patients. Generation of real-world data focusing on patients who received platinum-based chemotherapy combined with immune checkpoint inhibitors is under way.
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Affiliation(s)
| | | | - Didier Debieuvre
- Groupe Hospitalier de la Région de Mulhouse Sud Alsace, Mulhouse, France
| | - Hervé Lena
- Centre Hospitalier Universitaire de Rennes, Rennes, France
| | | | | | | | - Xavier Quantin
- Institut régional du Cancer de Montpellier, Montpellier, France
| | - Nicolas Girard
- Institut du Thorax Curie Montsouris, Institut Curie, Paris, France et Université Versailles Saint Quentin, Paris Saclay Campus, Versailles, France.
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Leroy K, Audigier Valette C, Alexandre J, Boussemart L, Chiesa J, Deldycke C, Gomez-Rocca C, Hollebecque A, Lehmann-Che J, Lemoine A, Mansard S, Medioni J, Monnet I, Mourah S, Pierret T, Spaëth D, Civet A, Galoin S, Italiano A. Retrospective analysis of real-world data to evaluate actionability of a comprehensive molecular profiling panel in solid tumor tissue samples (REALM study). PLoS One 2023; 18:e0291495. [PMID: 37708140 PMCID: PMC10501576 DOI: 10.1371/journal.pone.0291495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 08/23/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Considering the growing interest in matched cancer treatment, our aim was to evaluate the ability of a comprehensive genomic profiling (CGP) assay to propose at least one targeted therapy given an identified genomic alteration or signature (actionability), and to collect the treatment modifications based on the CGP test results in clinical practise for solid tumors. METHODS This retrospective, multicentre French study was conducted among 25 centres that participated in a free of charge program between 2017 and 2019 for a tissue CGP test. Data were collected on the patient, disease, tumor genomic profile, treatment suggested in the report (related to the genomic profile results) and subsequent therapeutic decisions according to the physician's declaration. RESULTS Among the 416 patients, most had lung cancer (35.6%), followed by biliary tract cancer (11.5%) or rare cancers (11.1%); 75% had a metastatic disease. The actionability was 75.0% (95% CI [70.6%-78.9%]) for all patients, 85.1% and 78.4%, respectively in lung cancer and metastatic patients. After exclusion of clinical trial suggestions, the actionability decreased to 62.3% (95% CI [57.5%-66.8%]). Treatment modification based on the test results was observed in 17.3% of the patients and was more frequent in metastatic disease (OR = 2.73, 95% CI [1.31-5.71], p = 0.007). The main reasons for no treatment modification were poor general condition (33.2%) and stable disease or remission (30.2%). The genomic-directed treatment changes were performed mostly during the first six months after the CGP test, and interestingly a substantial part was observed from six to 24 months after the genomic profiling. CONCLUSION This French study provides information on the real-life actionability of a CGP test based on tissue samples, and trends to confirm its utility in clinical practice across the course of the disease, in particularly for patients with lung cancer and/or advanced disease.
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Affiliation(s)
- Karen Leroy
- Université Paris Cité, Sorbonne Université, Inserm, Centre de Recherche des Cordeliers, Paris, France
- Département de Médecine Génomique des Tumeurs et Cancers, Service de Biochimie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Jérôme Alexandre
- Université Paris Cité, Sorbonne Université, Inserm, Centre de Recherche des Cordeliers, Paris, France
- Service d’Oncologie, AP-HP, Hôpital Cochin, Paris, France
| | - Lise Boussemart
- Service de Dermatologie, CHU de Nantes—Hôtel Dieu, Nantes, France
| | - Jean Chiesa
- UF de Cytogénétique et Génétique Médicale, Hôpital Universitaire Carémeau, Nîmes, France
| | | | | | | | - Jacqueline Lehmann-Che
- Université Paris Cité, INSERM U976, Immunologie Humaine, Pathophysiologie, Immunothérapie (HIPI), Paris, France
- UF Oncologie Moléculaire, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Antoinette Lemoine
- Biochimie et Oncogénétique–Inserm UMRS 1193, Hôpital Paul Brousse, AP-HP, Paris, France
| | | | - Jacques Medioni
- Centre d’Essais Précoces en Cancérologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Isabelle Monnet
- Service de Pneumologie, Hôpital Intercommunal de Créteil, Créteil, France
| | - Samia Mourah
- Université Paris Cité, INSERM U976, Immunologie Humaine, Pathophysiologie, Immunothérapie (HIPI), Paris, France
- Service de Génomique des Tumeurs et Pharmacologie, Hôpital Saint-Louis, AP-HP, Paris, France
| | | | - Dominique Spaëth
- Centre d’Oncologie de Gentilly, Institut Interrégional de Cancérologie, Nancy, France
| | - Alexandre Civet
- Centre de Données Médicales, Roche S.A.S, Boulogne-Billancourt, France
| | - Sandrine Galoin
- Affaires Médicales, Roche S.A.S, Boulogne-Billancourt, France
| | - Antoine Italiano
- Unité d’études de Phases Précoces, Institut Bergonié, Bordeaux, France
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Girard N, Perol M, Simon G, Audigier Valette C, Gervais R, Debieuvre D, Schott R, Quantin X, Coudert B, Lena H, Carton M, Robain M, Filleron T, Chouaid C. Treatment strategies for unresectable locally advanced non-small cell lung cancer in the real-life ESME cohort. Lung Cancer 2021; 162:119-127. [PMID: 34775215 DOI: 10.1016/j.lungcan.2021.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/05/2021] [Accepted: 10/31/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cisplatin-based chemotherapy administered concurrently to thoracic radiation therapy is the recommended treatment for fit patients with unresectable stage III NSCLC. The aim of this study was to describe patient profiles and clinical outcomes for the different treatment strategies in a real-word setting. METHODS The epidemio-strategy and medical economics (ESME) database for advanced and metastatic lung cancer is a French, national, multicenter, observational cohort. Out of 8514 Patients, 822 patients with unresectable locally advanced NSCLC in 2015-016 were selected (mean age, 65.3 years; male gender, 69%; performance status 0-1, 77%; smokers or former smokers, 89%). RESULTS Treatment was initiated for 736 (90%) of patients (concurrent chemoradiotherapy, n = 283; sequential chemoradiotherapy, n = 121; chemotherapy alone, n = 194; radiotherapy alone, n = 121; targeted therapy alone, n = 8; other, n = 9). Compared to the other treatment strategy groups, patients with radiotherapy alone appeared the most fragile (e.g. higher age, lower body weight or higher frequency of chronic obstructive pulmonary disease). OS rates at 12 and 24 months were 79.5% (95% CI, 73.4-84.3) and 55.3% (95% CI, 44.9-64.5) for concurrent chemoradiotherapy, and 64.3% (95% CI, 52.8-73.8) and 53.2 (95% CI, 33.2-69.6) for sequential chemoradiotherapy. CONCLUSIONS Real-world evidence shows that concurrent chemoradiotherapy is administered to the most fit patients with non resectable locally-advanced NSCLC. Clinical outcomes are actually higher than those reported in landmark clinical trials, which suggests that an optimized and individualized selection of patients allows for prolonged survival. Long-term outcomes are similar after sequential or concurrent chemoradiotherapy.
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Affiliation(s)
| | | | | | | | | | | | | | - Xavier Quantin
- Institut de Cancérologie de Montpellier, Montpellier, France
| | | | - Hervé Lena
- Centre Hospitalier Universitaire de Rennes, Rennes, France
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Baldacci S, Mazieres J, Tomasini P, Girard N, Guisier F, Valette CA, Monnet I, Wislez M, Pérol M, Dô P, Dansin E, Leduc C, Leprieur EG, Moro-Sibilot D, Kherrouche Z, Labreuche J, Cortot A. P3.02b-051 Outcome of Advanced EGFR-Mutated NSCLC Patients with MET-Driven Acquired Resistance to EGFR TKI. Results of the METEORE Study. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Levra MG, Mazieres J, Valette CA, Molinier O, Planchard D, Frappat V, Ferrer L, Toffart AC, Moro-Sibilot D. P1.07-012 Efficacy of Immune Checkpoint Inhibitors in Large Cell Neuroendocrine Lung Cancer: Results from a French Retrospective Cohort. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.923] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Levra MG, Novello S, Ferrer L, Barbieri F, Mazieres J, Westeel V, Girard N, Poudenx M, Le Treut J, Migliorino MR, Valette CA, Madroszyk A, Leduc C, Sanchez ML, Toffart AC, Moro-Sibilot D. P1.06-005 An International Cohort of Patients with Small Cell Lung Cancer after a Non-Small Cell Lung Carcinoma Oncogene or Non-Oncogene Addicted. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cortot A, Audigier Valette C, Molinier O, Le Moulec S, Barlesi F, Zalcman G, Dumont P, Pouessel D, Poulet C, Hiret S, Souquet PJ, Dixmier A, Renault PA, Langlais A, Lebitasy MP, Morin F, Moro-Sibilot D, Besse B. OA11.01 Prolonged OS of Patients Exposed to Weekly Paclitaxel and Bevacizumab: Impact of the Cross-Over in the IFCT-1103 ULTIMATE Study. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Moro-Sibilot D, Perol D, Chabaud S, Cadranel J, Audigier Valette C, Perol M. The TAILOR study: to agree or to disagree? Lung Cancer 2014; 84:315-6. [PMID: 24751106 DOI: 10.1016/j.lungcan.2014.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 03/11/2014] [Accepted: 03/17/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Denis Moro-Sibilot
- Thoracic Oncology Unit, Grenoble University Hospital and INSERM U823, France.
| | - David Perol
- Statistics Department, Centre Léon Bérard, Lyon, France
| | | | - Jacques Cadranel
- Pneumology Department, Hôpital Tenon, Paris, France; ER2 Paris VI University, France
| | | | - Maurice Perol
- Medical Cancerology Department, Centre Léon Bérard, Lyon, France
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